Changes in preoperative endoscopic and percutaneous bile drainage in patients with periampullary cancer undergoing pancreaticoduodenectomy in Ontario: effect on clinical practice of a randomized trial

Current oncology

M. E. Dixon¹  P. J. Karanicolas²  J. D. Mosko³  Q. Li⁴  N. Goyert⁵  A. C Wei⁶  D. J. Kagedan⁷ 

[1] Institute of Health Policy, Management, and Evaluation;Princess Margaret Cancer Centre, University Health Network;Sunnybrook Health Sciences Centre;Health Outcomes and PharmacoEconomic Research Centre;Institute for Clinical Evaluative Sciences;Sunnybrook Health Sciences Centre;University of Toronto

关键词: Pancreatic neoplasia;    resection;    periampullary tumours;    outcomes;   

DOI  :  10.3747/co.25.4007

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

BackgroundIn 2010, a multicentre randomized controlled trial reported increased postoperative complications in pancreaticoduodenectomy ( pde ) patients undergoing preoperative biliary decompression ( pbd ). We evaluated the effect of that publication on rates of  pbd  at the population level.MethodsThis retrospective observational cohort study identified patients undergoing  pde  for malignancy, 2005–2013, linking them with administrative health care databases covering medical services for a population of 13.5 million. Patients undergoing  pbd  within 6 weeks before their surgery were identified using physician billing codes and were divided into those undergoing  pde  before and after article publication, with a 6-month washout period. Chi-square tests were used to compare rates of  pbd .ResultsOf 1997  pde  patients identified, 963 underwent surgery before article publication, and 911, after (123 during the washout period). The rate of  pbd  was 47.5% before publication, and 41.6% after ( p  = 0.01). The lowest  pbd  rates occurred immediately after publication, in 2010 and 2011. Similar results were observed when the cohort was restricted to patients seen preoperatively by a gastroenterologist ( n  = 1412).ConclusionsRates of  pbd  have declined a small, but significant, amount after randomized trial publication. Persistence of  pbd  might relate to suboptimal knowledge translation, the role of  pbd  in diagnosis of periampullary malignancy, and treatment of complications (cholangitis, severe hyperbilirubinemia) or anticipation of delay from diagnosis to surgery. The nadir in  pbd  rates after article publication and the subsequent rise suggest an element of transience in the effect of article publication on clinical practice. Further investigation into the reasons for persistent  pbd  is needed.

【 授权许可】

Unknown